Effects

Effects are one major mechanic of The Binding of Isaac: Rebirth. There are a number of different items that alter the type of tears and the status effects they inflict.

Status Effects

Status Effects are special effects that can be inflicted on an enemy from a variety of sources, such as tears, bombs, and items. Each status effect has a colour and symbol/effect associated with them for easy identification. These colourations are not to be confused with champions.

Effect	Appearance	Description
Burn		Afflicted enemies take 4 to 6 fire damage over time, like poison. Afflicted enemies will be tinted orange for the duration and have a fire symbol above them. Afflicted enemies will sustain double Isaac's tear damage over time.
Charm		Afflicted enemies will temporarily fight on Isaac's side, running toward other enemies and damaging them. If no other enemies are in the room, a charmed enemy will instead run towards Isaac. (Charmed enemies can still hurt Isaac.) Afflicted enemies will be tinted pink for the duration and have a heart symbol above them. Most enemies with ranged attacks will not fire them. Charmed enemies will prioritize non-charmed enemies and won't target invincible enemies. Charmed Portals will also spawn permanently-charmed enemies.
Confusion		Afflicted enemies are slowed and walk around randomly. While confused, most non-boss enemies will be unable to attack. Afflicted enemies will be tinted pale gray and have stars above them.
Fear		Afflicted enemies are scared of Isaac and will run away from him. While scared, most non-boss enemies will be unable to attack or charge towards Isaac. Afflicted enemies will be tinted purple and have a skull symbol above them.
Petrified		Afflicted enemies are stopped in place. They cannot move or attack. Afflicted enemies will be shaded brown-gray, as if turned to stone (unless petrified by Midas' Touch, in which case they will be shaded gold).
Poison		Afflicted enemies sustain 4 to 6 damage over time. Afflicted enemies will be tinted green and have a bubbly effect surrounding them. Afflicted enemies will sustain double Isaac's tear damage over time.
Slow		Afflicted enemies are slowed down. Any projectiles they shoot will also be slowed down. Attacks that end when the enemy runs out of momentum, such as the charging attacks of Gurdy Jr. and Dingle, will be vastly shortened in duration. Depending on the item that triggers the slow effect, afflicted enemies will be tinted black or white with a snail icon above them.
Shrink		Afflicted enemies are shrunken and will run away from Isaac. Isaac can walk over shrunken enemies to kill them.
Bleed		Afflicted enemies take damage equal to 10% of their maximum health every 5 seconds.

Notes

• Host-type enemies will take burn and poison damage even if their skull is down, and all status effects can be applied by tears even if their skulls are down.

Burn

Passive Items that cause burning

Name	ID	Icon	Quote	Description
Fire Mind	257		Flaming tears	Grants flaming tears that deal burning damage over time. Tears have a chance to explode on impact with an enemy, which creates a fire at the location of the explosion.

Charm

Activated Items that cause charming

Name	ID	Icon	Quote	Description
Friendly Ball	382		Gotta fetch 'em all!	Throwing the ball at an enemy instantly kills it and captures it. The captured enemy can later be released and will be charmed until it dies, persisting between floors.
Kidney Bean	421		Love toots!	Upon use, Isaac farts, charming all nearby enemies.

Passive Items that cause charming

Name	ID	Icon	Quote	Description
Ball of Bandages	207		Gotta lick 'em all!	Orbiting familiar that deals damage to enemies. If collected while already having one, makes the familiar evolve. Only drops from Horsemen. Similar to Cube of Meat.
Betrayal	391		Turn your enemy	Every time Isaac takes damage, a charm effect is applied to every enemy in the room, causing them to attack each other rather than Isaac.
Bozo	513		Party time!	Increases damage by a flat 0.1 and grants a soul heart. Enemies can randomly become briefly charmed or feared. Taking damage has a chance to spawn a rainbow poop.
Glitter Bombs	432		Prize bombs!	Gives Isaac 5 bombs, and makes Isaac's bombs have a chance to drop random pickups or charm enemies when they explode.
Mom's Eyeshadow	200		Charm tears	Tears have a chance to charm enemies.

Active Items that create charmed enemies

Name	ID	Icon	Quote	Description
Book of the Dead	545		Rise from the grave	Upon use, spawns a charmed Bony or an orbital bone for each enemy killed in the current room.

Passive Items that create charmed enemies

Name	ID	Icon	Quote	Description
My Shadow	433		Me! And my shaaaadow!	Each time Isaac takes damage, inflicts fear on all enemies in the room and spawns a black Charger familiar that will attack enemies. The Charger will be killed if it is damaged too much.
Shade	468		It follows	Spawns a shadow familiar that follows Isaac's movements on a 1 second delay and deals contact damage to enemies.
Poke Go	505		Gotta catch em...	Upon entering a room with enemies in it, has a chance to spawn a random charmed enemy that persists across rooms.
Mystery Egg	539		Sacrificial insemination	Spawns an egg familiar, which cracks and turns into a random charmed enemy when Isaac is hurt. The egg regenerates upon entering a different room.

Notes

• First stage of Ball of Bandages cannot charm enemies. See Ball of Bandages for details.
• Charmed enemies will still target Isaac if they are the only enemy in the room.

Pills that cause charming

Pill	Effect
Pheromones	Charms all enemies in the room for a short period of time.

Confusion

Passive Items that cause confusion

Name	ID	Icon	Quote	Description
Butt Bombs	209		Toxic blast +5 bombs	Gives +5 bombs and makes all bombs Butt Bombs that fill the room with gas, damaging and confusing all enemies.
Glaucoma	460		Blind tears!	Adds a chance to shoot concussive tears, causing enemies to walk around randomly.
Iron Bar	201		Concussive tears	Increases damage by 0.3 and adds a chance to shoot concussive tears, causing enemies to walk around randomly.

Trinkets that cause confusion

Name	ID	Icon	Quote	Description
Faded Polaroid	69		You feel faded	Occasionally causes Isaac to blend into the ground, which briefly confuses all enemies in the room.

Fear

Activated Items that cause fear

Name	ID	Icon	Quote	Description
The Gamekid	93		Temporary Man-Pac	Upon use, turns the character into a into a Pac-Man-like creature for 5 seconds, granting invulnerability, inflicting fear on all enemies, and replenishing half a red heart container for every two enemies killed.
Mom's Pad	41		Gross...	Upon use, inflicts fear to all enemies in the room for 5 seconds.

Passive Items that cause fear

Name	ID	Icon	Quote	Description
Abaddon	230		Evil + DMG up + fear shot	Increases damage and speed, removes all red heart containers, grants six black hearts, and adds a chance to shoot fear tears.
Bozo	513		Party time!	Increases damage by a flat 0.1 and grants a soul heart. Enemies can randomly become briefly charmed or feared. Taking damage has a chance to spawn a rainbow poop.
Dark Matter	259		Fear shot	Increases Damage by 1 and adds a chance to shoot fear tears.
Mom's Perfume	228		Fear shot	Adds a chance to shoot fear tears and decreases tear delay by 1.
My Shadow	433		Me! And my shaaaadow!	Each time Isaac takes damage, inflicts fear on all enemies in the room and spawns a black Charger familiar that will attack enemies. The Charger will be killed if it is damaged too much.
Spear of Destiny	400		Your destiny	In addition to tears, Isaac now holds a spear in front of him which deals damage equal to 2 times his tear damage, and occasionally inflicts fear. The spear cannot be thrown, but deals damage while it is in contact with an enemy.

Petrification

Activated Items that petrify enemies

Name	ID	Icon	Quote	Description
The Boomerang	338		It will never leave you	Throws a short-range boomerang which does a bit of damage and has a high chance to stun the enemy for 2 seconds. Can also be used to grab pickups.
Mega Bean	351		Giga fart!	When used, the Mega Bean will freeze all enemies in the current room for a couple of seconds, deal 5 damage and poison any enemies near Isaac, and send a wave of spikes that deals 10 damage across the room in the direction Isaac is facing.
Mom's Bra	39		Mass Fear	Upon use, petrifies all enemies in the current room for approximately 4 seconds.

Passive Items that petrify enemies

Name	ID	Icon	Quote	Description
Charged Baby	372		Bbbzzzzzt!	A familiar that drops a Little Battery every 4 rooms. Has a small chance to freeze all enemies in the room when hit.
Dad's Ring	546		Father's blessing	Creates a ring of light around Isaac that petrifies enemies in contact.
Eye of Greed	450		Gold tears!	Adds a chance to fire tears that temporarily stun enemies and turn them into gold. Any enemy killed while in this state will drop coins.
Midas' Touch	202		Golden touch	Enemies that touch you are stunned and turn gold. Any enemy killed while in this state will drop a coin.
Mom's Contacts	110		Freeze effect	Adds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.

Poison

Activated Items that poison enemies

Name	ID	Icon	Quote	Description
The Bean	111		Toot on command	Isaac releases bad gas, poisoning any enemy in close vicinity.
Bob's Rotten Head	42		Reusable ranged bomb	Upon use, Isaac holds a poison bomb which can be thrown towards any of the four cardinal points and explodes on impact.
Mega Bean	351		Giga fart!	When used, the Mega Bean will freeze all enemies in the current room for a couple of seconds, deal 5 damage and poison any enemies near Isaac, and send a wave of spikes that deals 10 damage across the room in the direction Isaac is facing.

Passive Items that poison enemies

Name	ID	Icon	Quote	Description
The Black Bean	180		Toot on touch	When taking damage, Isaac farts, causing poison damage to all enemies in range.
Bob's Brain	273		Explosive thoughts	Spawns a familiar that charges forward when shooting tears and explodes upon contact with an enemy, damaging and poisoning them. The familiar respawns after a few seconds.
Bob's Curse	140		+5 poison bombs	Gives 5 bombs and grants all bombs poison effect.
The Common Cold	103		Poison Damage	Adds a chance to shoot poison tears, dealing damage over time when inflicted.
Ipecac	149		Explosive shots	Replaces tears with explosive and poisoning projectiles fired in an arc from the mouth.
Scorpio	305		Poison tears	Grants poison tears, which deal damage over time when inflicted.
Serpent's Kiss	393		The kiss of death	Tears now have a random chance to apply a poison effect, causing 4 or 6 damage per tick to enemies (Similar to The Common Cold item). Isaac now deals poison damage on contact with enemies similar to The Virus item (Damage over time 4 or 6 per tick). Enemies that were poisoned have a chance to drop a black heart when killed.
Toxic Shock	350		Mass poison	Upon entering a room, poisons all enemies, dealing double Isaac's tear damage. Killing enemies leaves a small, short lasting pool of green creep on the ground.
The Virus	13		Poison touch	Inflicts poison to enemies who make contact with Isaac. Speed down.

Trinkets that grant poison tears

Name	ID	Icon	Quote	Description
Pinky Eye	30		Poison shots	Adds a 10% chance to shoot a poison tear, dealing damage over time when inflicted.

Pills that poison enemies

Pill	Effect
Bad Gas	Isaac farts, poisoning enemies around him.

Slow

Activated Items that slow enemies

Name	ID	Icon	Quote	Description
The Hourglass	66		Temporary enemy slowdown	Upon activation, enemies and their projectiles are slowed down for a short duration.
Spider Butt	171		Mass enemy slowdown + damage	Damages all enemies in the room and slows them and their projectiles down.

Passive Items that slow enemies

Name	ID	Icon	Quote	Description
Ball of Tar	231		Sticky feet...	Adds a chance to shoot slowing tears and the character leaves a trail of slowing creep behind as he moves, impeding enemies' speed.
Broken Watch	337		I think it's broken	Chance upon entering a room to slow down or speed up every enemy and their attacks. The chance to slow enemies is quite higher than the chance to speed them up.
Censer	387		Peace be with you	Gives Isaac a golden censer familiar which creates a huge aura of light that slows down any enemies and enemy shots inside it.
Juicy Sack	266		Sticky babies	A familiar that follows behind Isaac. It drips a trail of creep, which slows enemies, and spawns 1-2 blue spiders after each room.
Little Gish	99		Sticky friend	Spawns a familiar that follows Isaac around and fires slowing tears, impeding enemies' speed.
Night Light	425		Scared of the dark?	A cone of light shines in the direction Isaac is moving that slows enemies and enemy shots.
Spider Bite	89		Slow effect	Adds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.
Stop Watch	232		Let's slow this down a bit	Automatically inflicts slow to all enemies in every room. Upon taking damage, inflicts slow to all enemies for the current room.

Notes

• The creep from Ball of Tar and Juicy Sack only slow enemies for as long as they remain in the creep.
• The Mask + Heart enemy is not affected by the slow effect.

Shrink

Passive Items that grant shrinking tears

Name	ID	Icon	Quote	Description
God's Flesh	398		Shrink shot	Tears now have a random chance to apply a shrinking effect, causing enemies to shrink in size and also run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.

Bleed

Passive Items that inflict bleed

Name	ID	Icon	Quote	Description
Backstabber	506		Watch your back!	Has a chance to fire tears that inflict bleeding on enemies, causing them to slowly take damage over time.

Random

These items inflict random status effects on enemies.

Passive Items that inflict random effects

Name	ID	Icon	Quote	Description
GB Bug	405		Game breaking bug, right away!	A glitch familiar that bounces around the room and applies a random status effect to any enemies it comes into contact with and has a chance to re-roll pickups that it passes over.
Spider Mod	403		Mod buddy!	Displays Isaac's tear damage and enemy health bars. Spawns a gray spider familiar that wanders around and inflicts a random status effect on any enemies it comes into contact with. Occasionally spawns a blue spider upon clearing a room.

Tear Effects

This article is about Isaac's primary weapon. For the attribute of the same name that governs rate of fire, see Attributes.

Tear Effects modify the player character's primary weapon — tears. A few of the most common tear effects are listed below.

Homing Tears

Homing Tears slightly divert from their path and seek nearby enemies. The distance homing tears can travel is determined by the range stat.

Activated Items that grant homing tears

Name	ID	Icon	Quote	Description
Telepathy for Dummies	192		Temporary psychic shot	Upon activation, grants homing tears for the current room.

Passive Items that grant homing tears

Name	ID	Icon	Quote	Description
Sacred Heart	182		Homing shots + DMG up	Increases damage and range while reducing shot speed and grants homing tears. Grants a Heart Container and replenishes all Red Hearts.
Spoon Bender	3		Homing shots	Grants Isaac homing tears.
Godhead	331		God tears	Increases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.

Familiars that fire homing tears

Name	ID	Icon	Quote	Description
Little Steven	100		Psychic friend	Spawns a familiar that follows Isaac around and fires homing tears.
Seraphim	390		Sworn friend	An angel familiar which follows Isaac and fires homing tears which deal 10 damage at -25% shot speed and a reduced fire rate.

Cards that grant homing tears

Name	ID	Icon	Message	Effect
I - The Magician	2		May you never miss your goal	Grants homing tears for the current room.

Piercing Tears

Piercing tears travel through enemies (but not obstacles) instead of breaking on impact with them. While they do not directly increase damage, piercing tears can allow the character to deal a greater amount of damage per second due to the multiple impact calculations on large bosses and the possibility to hit multiple enemies at once.
The downside of piercing tears is that they remove knockback.

Passive Items that grant piercing tears

Name	ID	Icon	Quote	Description
Cupid's Arrow	48		Piercing shots	Grants Isaac piercing tears that travel through enemies (but not obstacles) instead of breaking on impact with them.
Dead Onion	336		Toxic aura tears	Grants piercing and spectral tears. Increases tear size (without increasing damage) while greatly reducing range and shot speed.
Death's Touch	237		Penetrative shot + damage up	Increases Damage by 1.5, reduces Tears by 0.3 and increases tear size. Grants piercing tears. Tears are replaced by Death's scythes, which is a cosmetic effect only.
Eye of Belial	462		Possessed tears!	Grants piercing tears. After piercing one enemy, tears start homing and deal double damage.
Sagittarius	306		Penetrative shot + speed up	Increases speed by +0.2 and grants piercing tears.

Trinkets that grant piercing tears

Name	ID	Icon	Quote	Description
Push Pin	31		Piercing shots	Adds a 10% chance to shoot a piercing and spectral tear.

Spectral Tears

Spectral tears travel through obstacles (but not enemies) instead of breaking on impact with them. Spectral tears can be used to safely dispatch most types of monsters from behind obstacles, or over them in combination with flying.

Passive Items that grant spectral tears

Name	ID	Icon	Quote	Description
Dead Dove	185		Flight + spectral tears	Grants spectral tears and flight.
Dead Onion	336		Toxic aura tears	Grants piercing and spectral tears. Increases tear size (without increasing damage) while greatly reducing range and shot speed.
Ouija Board	115		Spectral tears	Grants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.
Pupula Duplex	379		Wide shot	Transforms Isaac's tears into a wide arc shape which gives them a much larger hitbox. Gives Isaac spectral tears which allows them to travel through objects in the environment (i.e. rocks).
Spirit of the Night	159		Scary	Grants spectral tears and flight.

Familiars that fire spectral tears

Name	ID	Icon	Quote	Description
Ghost Baby	163		Spectral buddy	Spawns a familiar that follows Isaac around and fires spectral tears.

Trinkets that grant spectral tears

Name	ID	Icon	Quote	Description
Ouroboros Worm	96		Foop foop!	Tears travel in a large spiral pattern and become spectral.
Push Pin	31		Piercing shots	Adds a 10% chance to shoot a piercing and spectral tear.

Temporary Buffs

Temporary buffs are beneficial effects applied to the player character that will expire after a timed duration or on leaving a room, and are not tear effects.

Invulnerability

Invulnerability negates all types of damage for five seconds, including health loss from Blood Donation Machines and Devil Beggars, environmental hazards like spikes, and Curse Rooms doors and Sacrifice Rooms, but does not prevent heart container or Soul Heart loss from Health Down Pills, Devil Room deals, or spawning a baby.
While under the effects of invulnerability, the character has increased speed, loses the ability to shoot tears, flashes in multiple colors, and the music of the game speeds up. However, all invulnerability-granting items except for the Unicorn Stump also grant the character the ability to damage enemies by contact for the duration of the effect.

Activated Items that grant invulnerability

Name	ID	Icon	Quote	Description
My Little Unicorn	77		Temporary badass	Upon use, grants invulnerability and increased speed for five seconds, removing the ability to shoot tears and replacing it with the ability to deal contact damage to enemies.
The Gamekid	93		Temporary Man-Pac	Upon use, turns the character into a into a Pac-Man-like creature for 5 seconds, granting invulnerability, inflicting fear on all enemies, and replenishing half a red heart container for every two enemies killed.
Unicorn Stump	298		You feel stumped	Upon use, grants invulnerability and increased speed for five seconds, but removes the ability to shoot tears.

Passive Items that grant invulnerability

Name	ID	Icon	Quote	Description
Taurus	299		Speed down + rage is building	Speed down; gains speed while in a room with enemies until gaining My Little Unicorn effect for a few seconds.

Trinkets that grant invulnerability

Name	ID	Icon	Quote	Description
Cartridge	8		I remember these	Chance to trigger The Gamekid effect upon taking damage.

Cards that grant invulnerability

Name	ID	Icon	Message	Effect
VII - The Chariot	8		May nothing stand before you	Grants the temporary invulnerability effect of My Little Unicorn.

Shield

A shield negates all types of damage for a variable amount of time, depending on the item it's granted by, including health loss from Blood Donation Machines and Devil Beggars, environmental hazards like spikes, and Curse Rooms doors and Sacrifice Rooms, but does not prevent heart container or Soul Heart loss from Health Down Pills, Devil Room deals, or spawning a baby.
Unlike invulnerability, the shield does not prevent the character from attacking.

Activated Items that grant a shield

Name	ID	Icon	Quote	Description
Book of Shadows	58		Temporary Invincibility	Upon use, creates a protective shield nullifying all types of damage for 10 seconds.

Passive Items that grant a shield

Name	ID	Icon	Quote	Description
Celtic Cross	162		You feel blessed	Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds.
Empty Vessel	409		I reward an empty vessel	While Isaac has no red hearts, this item grants flight and a random chance to activate an invincibility shield for a few seconds. If Isaac gains any red hearts, these benefits will disappear.
The Polaroid	327		Fate Chosen	If the character has half a red heart or no red hearts after taking damage, it triggers the Book Of Shadows effect, creating a shield that nullifies all types of damage for 5 seconds. Also allows entrance into The Chest.
Virgo	303		You feel refreshed and protected	Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 10 seconds. Also converts "bad pills" into "good pills".

Runes that grant a shield

Rune	ID	Icon	Unlock method	Message	Effect
Algiz	39		Complete challenge #8Rune of Algiz	Resistance	Grants a shield which lasts for 30 seconds.